Purpose: To identify factors influencing patients' anti-retroviral therapy (ART) adherence at four clinics in Botswana.
Design: Quantitative descriptive. Structured interviews were conducted with a random sample of 400 patients out of the population of all patients attending the four randomly selected ART clinics in Botswana during April and May 2007.
Methods: Data were analysed using SPSS version 13. Chi-square and p-value calculations were done to test significance of the relationships between categories or variables.
Findings: Patient-centred barriers to ART adherence included inadequate knowledge about ART, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), CD4 cell and viral-load results, stigma, travelling costs, waiting times at clinics, side effects of ART, use of traditional (indigenous or folk) medicines, and abuse of alcohol. Service-centred barriers included nurses' attitudes and knowledge, health workers' inability to conduct home visits and to contact defaulters, limited clinic hours, delays in getting CD4 and viral-load results.
Conclusions: ART adherence requires more than free ART. Adherence levels will improve if both patient-centred and service-centred barriers are addressed.
Clinical relevance: Nurses play key roles in educating patients about ART adherence and side effects, but they should also educate patients about CD4 and viral-load test results and about the dangers of using traditional medicines and alcohol with ART. Shorter waiting times at clinics could make ART patients' lives more manageable.